For submission between 9am, April 13 and 8pm, May 8 for District-Level Elections on May 23, 2020. Please complete this form to be credentialed to vote in the District-Level Delegate Elections. After Registration closes on Friday, May 8, your email address and phone number will be provided to qualified candidates for Delegate in your District so they can contact you for your vote. On Saturday, May 23, you will be emailed a Ballot to complete that day to make your choices for Delegates to represent you at the Democratic National Convention. If you have questions, please contact justin@georgiademocrat.org

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Complete Name *

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Congressional District where you live and are registered to vote: *

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Complete home Street Address, City, ZIP *

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Home Phone *

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Mobile Phone *

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Email address *

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By declaring your preferred presidential candidate, you are agreeing to vote in the election of delegates to support that particular candidate and only that candidate. PREFERRED PRESIDENTIAL CANDIDATE: *

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Type your INITIALS here to signify and proclaim that the following statement is true: I believe in the goals of the Democratic Party of Georgia. *

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Type your INITIALS here to signify and proclaim that the following statement is true: I am not a member of any other political party or body as defined in the Georgia Election Code. *